How can I effectively lower my Sex Hormone-Binding Globulin (SHBG) level of 95 nmol/L to alleviate symptoms of low libido?

Lowering Elevated SHBG to Address Low Libido

Rather than directly targeting SHBG reduction, you should focus on identifying and treating the underlying cause of your symptoms, as SHBG elevation is typically a marker of other conditions rather than a primary problem requiring direct treatment. 1

Understanding Your Situation

Your SHBG level of 95 nmol/L is elevated (normal range approximately 7-50 nmol/L). 2 However, the critical issue is not the SHBG number itself, but rather your free (bioavailable) testosterone level and what's causing the SHBG elevation. 1

Essential First Steps

You must measure your total morning testosterone and calculate your free testosterone or androgen index before pursuing any treatment. 1 This is crucial because:

• Up to 50% of men with low total testosterone actually have normal free testosterone when SHBG is elevated, preventing unnecessary treatment 1
• If your morning testosterone is <300 ng/dL, testosterone deficiency may be contributing to your low libido 2, 1
• Free testosterone measurement is more clinically relevant than total testosterone when SHBG is abnormal 1

Common Causes of Elevated SHBG to Investigate

Medical Conditions That Raise SHBG

Screen for these conditions that directly increase SHBG: 2

• Hyperthyroidism - Check TSH and free T4 2, 1
• Liver disease - Even compensated cirrhosis raises SHBG, though it eventually declines with decompensation 2
• HIV/AIDS 2
• Aging - SHBG naturally increases with age 2

Medications That Raise SHBG

Review your current medications for these SHBG-elevating drugs: 2

• Anticonvulsants
• Estrogens or estrogen-containing compounds
• Thyroid hormone (if over-replaced)

Conditions That Lower SHBG (Potential Treatment Targets)

If no underlying cause is found, these interventions can reduce SHBG, though they should only be pursued if clinically appropriate: 2

Metabolic Optimization

• Weight loss if obese - Obesity, insulin resistance, metabolic syndrome, and type 2 diabetes all lower SHBG 2, 1
• Improve insulin sensitivity - This is one of the most physiologic ways to reduce SHBG 2

Hormonal Interventions (Require Medical Supervision)

Testosterone replacement therapy directly lowers SHBG 3:

• In hypogonadal men treated with testosterone enanthate 200mg IM every 2 weeks, SHBG fell from 16.4 to 4.3 ng DHT bound/mL 3
• This only applies if you have confirmed testosterone deficiency (<300 ng/dL morning level) 1
• Contraindicated in prostate cancer or if trying to conceive 2

Growth hormone lowers SHBG but is not indicated for this purpose 2, 4

Danazol (an androgenic steroid) markedly suppresses SHBG in a dose-dependent manner but has significant side effects and is not used for this indication 5

Critical Warnings

The Oxandrolone Trap

Avoid oral anabolic steroids like oxandrolone - While they dramatically lower SHBG through first-pass hepatic metabolism, this can paradoxically worsen symptoms by increasing testosterone clearance, leading to erectile dysfunction despite testosterone replacement 6

Address Underlying Causes First

Before attempting to lower SHBG, rule out and treat: 1

• Medications causing sexual dysfunction - Beta-blockers, SSRIs, spironolactone, finasteride 1
• Depression and anxiety - Major contributors to low libido that require psychiatric treatment 1
• Prolactin elevation - Should be measured if testosterone is low or libido loss is primary complaint 1
• Thyroid dysfunction - Both hyper- and hypothyroidism affect sexual function 2, 1

Recommended Diagnostic Algorithm

1. Measure total morning testosterone (before 10 AM) 1
2. Calculate free testosterone or androgen index 1
3. If testosterone <300 ng/dL, measure LH and prolactin to distinguish primary from secondary hypogonadism 1
4. Check TSH and free T4 1
5. Screen for metabolic syndrome - Fasting glucose or HbA1c, lipid panel 1
6. Review all medications for sexual side effects 1

Treatment Based on Findings

If free testosterone is normal despite elevated SHBG: Your symptoms likely have another cause - refer to sexual health specialist 1

If testosterone <300 ng/dL with symptoms: Testosterone replacement therapy is indicated and will simultaneously lower SHBG and improve symptoms 2, 1, 3

If metabolic syndrome is present: Weight loss and insulin sensitization will lower SHBG and may improve symptoms 2

If medication-induced: Consider switching beta-blockers to ACE inhibitors or calcium channel blockers, or changing SSRIs 1